Food

NCIMS HACCP Hazard Analysis Worksheet

Return to Dairy Grade A Voluntary HACCP

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SUBJECT: Hazard Analysis Worksheet

PLANT NAME:   

ADDRESS:   

ISSUE DATE: 

SUPERSEDES: 

PRODUCT: 

PAGE:  

(1)
Ingredient/Processing Step
(2)
Identify potential food safety hazards introduced, controlled or enhanced[1] at this step.
(3)
Are any potential
food-safety
hazards reasonably likely to occur?
(4)
Justify your decision for column 3
(5)
What control measure(s) can be applied to prevent, reduce, or eliminate the food safety hazards?
(6)
Is this step a critical
Control point?
(Yes/No)
 

Biological

Physical

Chemical

[ ] YES  [ ] NO

[ ] YES  [ ] NO

[ ] YES  [ ] NO

  

[ ] YES  

[ ] NO

 

Biological

Physical

Chemical

 [ ] YES  [ ] NO

 [ ] YES  [ ] NO

 [ ] YES  [ ] NO

  

[ ] YES  

[ ] NO

Instructions and Example

Raw Milk Receiving

[2] BiologicalVegetative PathogensYesLikely to occur based on historical dataPasteurization[5] No
[3] PhysicalNone(Leave Blank)(Leave Blank)(Leave Blank)
[4] ChemicalAnimal drug residuesNoAppendix N Testing in PP #5 Protection from Adulteration(Leave Blank)

Approved By:_____________________________________________________ Date:_____________________________
(Signature)

[1] Do not carry the hazard through subsequent steps.

[2] If a firm identifies a potential hazard in column 2 and yes is noted in column 3, justification is required in column 4 (This justification normally includes the scientific, regulatory, or historical reasons for the decision) and a control measure is required in column 5.

[3] If a firm does not identify a potential hazard in column 2, then columns 3, 4 and 5 will be blank.

[4] If a firm identifies a potential hazard in column 2 and No is noted in column 3, justification is required in column 4. This justification normally includes Prerequisite Programs or procedures that manage the hazard to ensure that control at this step is not necessary. Column 5 will be left blank.

[5] Column 6 will be answered yes only if the step in column 1 is a critical control point. The control measure is applied at that step.

Page Last Updated: 08/06/2015
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